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The Non-Insured Health Benefits (NIHB) Program provides supplementary health benefits, including prescription and non-prescription drugs, for registered First Nations and recognized Inuit throughout Canada.

Benefit definitions

Open benefits:

Open benefits are the drugs listed in the NIHB Drug Benefit List (DBL) which do not have established criteria or prior approval requirements.

Limited use benefits:

Limited use drugs are those that have been found to be effective in specific circumstances, or which have quantity and frequency limitations. For drugs in this category, specific criteria must be met to be eligible for coverage.

Not added to the formulary:

Drugs not added to formulary are those which are not listed in the NIHB DBL after review by the national Common Drug Review (CDR)/pan-Canadian Oncology Drug Review (pCODR) processes and/or the NIHB Drugs and Therapeutics Advisory Committee (DTAC). These drugs will not be added to the NIHB drug list because published evidence does not support the clinical value or cost of the drug relative to existing therapies. Coverage may be considered in special circumstances upon receipt of a completed "Exception Drugs Request Form" from the attending licensed practitioner. These requests are reviewed on a case by case basis.

Exclusion:

Certain drug therapies for particular conditions fall outside the NIHB Program's mandate and will not be provided as benefits (e.g., cosmetic and anti-obesity drugs). As well, certain drugs will be excluded from the NIHB Program as recommended by the CDR and the DTAC because published evidence does not support the clinical value, safety or cost of the drug relative to existing therapies, or there is insufficient clinical evidence to support coverage.

Note: The appeal process and the emergency supply policy does not apply to excluded drugs.

Additions to the Drug Benefit List

DIN

(Drug Identification Number)

MFR

(Manufacturer)

ST

(Short-Term Dispensing Policy Drug)

Open Benefits

Table 1 - Single-Source Drug Products

DIN

MFR

Brand Name

Effective Date

02430932

VII

TRIUMEQ 600/50/300MG TABLET

08-02-2017

02449277

TRI

ST ASA 81MG TABLET

23-11-2016

02442256

ORM

ST VIDEXTRA 2,000U CAPSULE

05-01-2017

02446561

GSK

ARNUITY ELLIPTA 100MCG/BLD INHALER

17-02-2017

02446588

GSK

ARNUITY ELLIPTA 200MCG/BLD INHALER

17-02-2017

02244290

PAL

METADOL-D 10MG/ML O/L

08-02-2017

02213826

TEP

REVIA 50MG TABLET

05-11-2016

01967878

SCH

CLEAR AWAY PLANTAR WART SYSTEM

30-11-2016

99401033

UNK

SHARPS NESTABLE YELLOW LARGE 22.7L

30-11-2016

01902776

SAO

KAYEXALATE 100%

17-01-2017

Table 2 - Multi-Source Drug Products

DIN

MFR

Brand Name

Effective Date

02454513

AUR

AURO-ABACAV/LAMIVUD 600/300MG

11-01-2017

02458381

PMS

PMS-ABACAV/LAMIVUD 600/300MG

27-01-2017

02452324

MAR

MAR-AZITHROMYCIN 250MG TABLET

21-01-2017

02429063

SDZ

VISTITAN 0.03%

11-01-2017

02447851

SAN

ST BUSPIRONE 10MG TABLET

28-11-2016

80025360

JAP

J-CAL-D 400 TABLET

19-12-2016

80065914

RIV

RIVA-CAL D400 TABLET

20-12-2016

02450526

PDL

ST CETIRIZINE 20MG TABLET

23-11-2016

02436914

AUR

AURO-CLINDAMYCIN 300MG CAPSULE

11-01-2017

02454297

ATP

ST ACT ESCITALOPRAM ODT 10MG TABLET

09-01-2017

02454300

ATP

ST ACT ESCITALOPRAM ODT 20MG TABLET

09-01-2017

02398869

MYL

ST INDAYO 0.15MG AND 0.03MG TABLET

06-12-2016

02448424

BMI

ST BIO-FLUOXETINE 10MG CAPSULE

07-11-2016

02448432

BMI

ST BIO-FLUOXETINE 20MG CAPSULE

07-11-2016

02423650

AUR

ST AURO-LOSARTAN-HCTZ 100/12.5MG

28-11-2016

02423669

AUR

ST AURO-LOSARTAN-HCTZ 100/25MG

28-11-2016

02423642

AUR

ST AURO-LOSARTAN-HCTZ 50/12.5MG

28-11-2016

09991474

UNK

NALOXONE NASAL SPRAY

22-12-2016

02444275

APX

APO-NALTREXONE 50MG TABLET

04-11-2016

02448734

AUR

ST AURO-OLANZAPINE ODT 10MG TABLET

30-11-2016

02448742

AUR

ST AURO-OLANZAPINE ODT 15MG TABLET

30-11-2016

02448726

AUR

ST AURO-OLANZAPINE ODT 5MG TABLET

30-11-2016

80033602

JAP

ST JAMP-K EFFERVESCENT 25MMOL TABLET

07-12-2016

02424061

AUR

ST AURO-PRAMIPEXOLE 0.25MG TABLET

30-11-2016

02424118

AUR

ST AURO-PRAMIPEXOLE 1.5MG TABLET

30-11-2016

02424096

AUR

ST AURO-PRAMIPEXOLE 1MG TABLET

30-11-2016

02442582

AUR

ST AURO-ROSUVASTATIN 10MG TABLET

27-01-2017

02442590

AUR

ST AURO-ROSUVASTATIN 20MG TABLET

27-01-2017

02442604

AUR

ST AURO-ROSUVASTATIN 40MG TABLET

27-01-2017

02442574

AUR

ST AURO-ROSUVASTATIN 5MG TABLET

27-01-2017

02453568

AUR

ST AURO-TELMISARTAN 40MG TABLET

11-01-2017

02453576

AUR

ST AURO-TELMISARTAN 80MG TABLET

11-01-2017

02456389

AUR

ST AURO-TELMISARTAN-HCTZ 80/12.5

11-01-2017

02456397

AUR

ST AURO-TELMISARTAN-HCTZ 80/25MG

11-01-2017

02432102

MAR

ST MAR-TOPIRAMATE 100MG TABLET

06-12-2016

02432110

MAR

ST MAR-TOPIRAMATE 200MG TABLET

06-12-2016

02432099

MAR

ST MAR-TOPIRAMATE 25MG TABLET

06-12-2016

02454645

SAN

VALACYCLOVIR 500MG TABLET

06-12-2016

02452855

AUR

ST AURO-VENLAFAXINE XR 150MG CAPSULE

06-12-2016

02452839

AUR

ST AURO-VENLAFAXINE XR 37.5MG CAPSULE

28-11-2016

02452847

AUR

ST AURO-VENLAFAXINE XR 75MG CAPSULE

06-12-2016

02450488

MYL

ST MYLAN-VERAPAMIL SR 180MG TABLET

07-11-2016

New limited use

Table 3 – Entecavir

DIN

MFR

Brand Name

Effective Date

02448777

AUR

AURO-ENTECAVIR 0.5MG TABLET

07-11-2016

Limited use benefit (prior approval required).

For the treatment of chronic hepatitis B infection in patients with cirrhosis documented on radiologic or histologic grounds and a HBV DNA concentration above 2000IU/mL.

Table 4 – Mirabegron

DIN

MFR

Brand Name

Effective Date

02402874

AST

ST MYRBETRIQ 25MG TABLET

22-11-2016

02402882

AST

ST MYRBETRIQ 50MG TABLET

22-11-2016

Limited Use (prior approval required).

For the symptomatic relief of overactive bladder in patients:

With symptoms of urinary frequency, urgency or urge incontinence; AND

Who have failed on or are intolerant to therapy with immediate-release oxybutynin OR solifenacin OR tolterodine ER.

Table 5 – Dapagliflozin

DIN

MFR

Brand Name

Effective Date

02435470

AZE

ST FORXIGA 10MG TABLET

08-02-2017

02435462

AZE

ST FORXIGA 5MG TABLET

08-02-2017

Limited use benefit (prior approval required).

For the treatment of patients with type 2 diabetes mellitus who did not achieve glycemic control or who demonstrated intolerance to an adequate trial of metformin AND a sulfonylurea.

Table 6 – Eplerenone

DIN

MFR

Brand Name

Effective Date

02323052

PFI

INSPRA 25MG TABLET

16-12-2016

02323060

PFI

INSPRA 25MG TABLET

16-12-2016

Limited use benefit (prior approval required).

For the treatment of patients with New York Heart Association (NYHA) class II chronic heart failure with left ventricular systolic dysfunction (with ejection fraction ≤ 35%), as an adjunct to standard therapy.

Patients must be on optimal therapy with an angiotensin-converting-enzyme (ACE) inhibitor or an angiotensin-receptor blocker (ARB), and a beta-blocker (unless contraindicated) at the recommended dose or maximal tolerated dose.

Table 7 – Fluticasone-Vilanterol

DIN

MFR

Brand Name

Effective Date

02444186

GSK

BREO ELLIPTA 200/25MCG INHALER

16-12-2016

Limited use benefit (prior approval required).

For the treatment of asthma in patients who are not adequately controlled on medium doses of inhaled corticosteroids (e.g. fluticasone 251-500mcg daily, or the equivalent) as the sole agent and require addition of a long-acting beta agonist. Patients using this combination product must also have access to a short-acting bronchodilator for symptomatic relief.

Table 8 – Idelalisib

DIN

MFR

Brand Name

Effective Date

02438798

GIL

ZYDELIG 150MG TABLET

30-01-2017

02438801

GIL

ZYDELIG 150MG TABLET

30-01-2017

Limited use benefit (prior approval required).

Criteria for initial six month coverage of Zydelig:

For the treatment of patients with relapsed chronic lymphocytic leukemia (CLL) in combination with rituximab. Treatment should continue until unacceptable toxicity or disease progression.

Criteria for assessment every six months:

There is no objective evidence of disease progression.

Table 9 – Insulin Pump Supplies

DIN

MFR

Brand Name

Effective Date

97799342

UNO

INSET 30 INFUSION SETS, 43"

13-01-2017

Limited use benefit (prior approval required).

Patient has type 1 diabetes; AND The insulin pump is prescribed by an endocrinologist or a specialist prescriber with experience in the use of insulin pumps in children, adolescent and/or adults.

For the treatment of adult patients with a diagnosis of mild to moderate idiopathic pulmonary fibrosis (IPF) who meet the following criteria:

Diagnosis confirmed by a respirologist and a high-resolution CT scan within the previous 24 months; AND

All other causes of restrictive lung disease (e.g. collagen vascular disorder or hypersensitivity pneumonitis) should be excluded; AND

Mild to moderate IPF is defined as forced vital capacity (FVC) greater than or equal to 50% of predicted; AND

Patient is under the care of a physician with experience in IPF.

Renewal at 6 months - Coverage is provided for a period of 6 months.

Patients must NOT demonstrate progression of disease defined as an absolute decline in percent predicted FVC of ≥ 10% from initiation of therapy until renewal (initial 6 month treatment period). If a patient has experienced progression as defined above, then the results should be validated with a confirmatory pulmonary function test conducted 4 weeks later.

Subsequent Renewals at 12 months and thereafter - Coverage is provided for a period of 12 months.

Patients must NOT demonstrate progression of disease defined as an absolute decline in percent predicted FVC of ≥ 10% within any 12 month period. If a patient has experienced progression as defined above, then the results should be validated with a confirmatory pulmonary function test conducted 4 weeks later.

For the treatment of adult patients with a diagnosis of mild to moderate idiopathic pulmonary fibrosis (IPF) who meet the following criteria:

Diagnosis confirmed by a respirologist and a high-resolution CT scan within the previous 24 months; AND

All other causes of restrictive lung disease (e.g. collagen vascular disorder or hypersensitivity pneumonitis) should be excluded; AND

Mild to moderate IPF is defined as forced vital capacity (FVC) greater than or equal to 50% of predicted; AND

Patient is under the care of a physician with experience in IPF.

Renewal at 6 months - Coverage is provided for a period of 6 months.

Patients must NOT demonstrate progression of disease defined as an absolute decline in percent predicted FVC of ≥ 10% from initiation of therapy until renewal (initial 6 month treatment period). If a patient has experienced progression as defined above, then the results should be validated with a confirmatory pulmonary function test conducted 4 weeks later.

Subsequent Renewals at 12 months and thereafter - Coverage is provided for a period of 12 months.

Patients must NOT demonstrate progression of disease defined as an absolute decline in percent predicted FVC of ≥ 10% within any 12 month period. If a patient has experienced progression as defined above, then the results should be validated with a confirmatory pulmonary function test conducted 4 weeks later.

Table 13 – Rifaximin

DIN

MFR

Brand Name

Effective Date

02410702

SLX

ZAXINE 550MG TABLET

09-11-2016

Limited use benefit (prior approval required).

For reducing the risk of overt hepatic encephalopathy (HE) recurrence in patients:

Who are unable to achieve adequate control of HE recurrence with a maximal tolerated dose of lactulose alone; AND

When used in combination with a maximal tolerated dose of lactulose.

Table 14 – Rizatriptan

DIN

MFR

Brand Name

Effective Date

02441144

AUR

AURO-RIZATRIPTAN 10MG TABLET

17-01-2017

Limited use benefit (prior approval not required).

A total of 12 tablets are permitted in a 30-day period.

Table 15 – Vitamin E

DIN

MFR

Brand Name

Effective Date

00330191

JAM

ST VITAMIN E 800IU NAT SOURCE CAPSULE

19-01-2017

Limited use benefit (prior approval required).

For use in malabsorption.

Criteria changes

Change in Coverage of Aptivus

Effective December 6, 2016, Aptivus became an open benefit

The following DINs were affected:

02273322

APTIVUS 250MG CAPSULE

Change in Coverage of Celsentri

Effective December 6, 2016, Celsentri became an open benefit

The following DINs were affected:

02299844

CELSENTRI 150MG TABLET

Change in Coverage of Intelence

Effective December 6, 2016, Intelence became an open benefit

The following DINs were affected:

02306778

INTELENCE 100MG TABLET

02375931

INTELENCE 200MG TABLET

Change in Coverage of Isentress

Effective December 6, 2016, Isentress became an open benefit

The following DINs were affected:

02301881

ISENTRESS 400MG TABLET

Change in Coverage of Bismuth in Tablets and Suspension (Pepto-bismol)

Effective January 3, 2017, bismuth products (Pepto-Bismol) in tablet and suspension form will have a frequency limit. The maximum amount will be 8 tablets per day for 14 days or 120mL per day of the liquid for 14 days. The NIHB Drugs and Therapeutics Advisory Committee recommended the change in listing status following the review of clinical evidence for bismuth. Evidence of efficacy was only found for the treatment of H. pylori infection for up to 14 days.

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